Focusing on the nineteenth and early twentieth century, this project explores the effects of public health programs in American cities and towns on morbidity, mortality, and labor force participation. In particular, the project has four specific aims. The first aim is to measure the effect of public health programs (e.g., the construction of water and sewerage systems) on health and labor force participation among Union army veterans. The second aim is to assess the impact of long-term lead exposure on health and labor force participation. We will examine, for example, the health effects of occupational exposure and the use of lead water mains by American cities. The third aim is to assess the distributional effects of public health programs. For example, did cities install fewer water and sewer mains in poor neighborhoods, particularly in African-American neighborhoods, than in wealthy neighborhoods? The fourth aim is to measure the effectiveness of alternative institutions (e.g., households, private enterprises, or government authorities) in promoting public health.